Personalization is the future of healthcare. New technologies such as artificial intelligence, virtual reality, blockchain, and wearable devices -- all connected in the cloud -- are making possible the democratization of diagnosis, medical knowledge, and patient care. This episode explores the near-term future of healthcare, in which with every stakeholder, doctor, pharmacist, payer and patient receives the personalized information they need to make better informed decisions.

Richie Etwaru is the Chief Digital Officer at QuintilesIMS, a healthcare analytics company with $8 billion in revenue. A frequent keynote speaker at leading tech-related events and forums, Richie casts a vision of a technologically-enabled healthcare system in the near future. He is also a serial entrepreneur who has started several companies, as well as an author and regular contributor to Forbes.com, CIO.com and Huffington Post. Richie was a former Clinton Global Initiative delegate and currently serves as a board member for multiple not-for-profit organizations.

Transcript

Michael Krigsman: Welcome to Episode #235 of CxOTalk. I’m Michael Krigsman, an industry analyst and the host of CxOTalk. We have a great show, today. We’re going to be speaking with Richie Etwaru, who is the Chief Digital Officer of QuintelesIMS. It’s a really large healthcare company, and we’re going to be talking about the future of healthcare.

Before we begin, I want to say “thank you” to Livestream, which is our livestreaming partner. And, they will give you a discount on the plan if you go to Livestream.com/CxOtalk. So, thank you, Livestream. You guys are great and we love you!

So, diving in, Richie Etwaru, how are you, today?

Richie Etwaru: Hey, Michael! I’m doing fantastic, man! First of all, thank you for having me for a second time. And congratulations on keeping this show going. You’ve been a this, for what, a couple of years now? And it just keeps getting better and better; more engagement, more content, better guests, congratulations. A lot of theses start and die, but yours keeps getting better so I’m really thankful to be here.

Michael Krigsman: Hey, thank you so much! Well, you know, it’s the guests that make it, and I feel so lucky to be able to have conversations like this with folks like yourself. So, Richie, tell us about QuinteilesIMS.

Richie Etwaru: We’re a vendor that’s about 50,000 employees, about 8 billion dollars of revenues, and we’re specifically focused on the life sciences industry. It’s two things that are fairly unique about us. The first is that we operate in four archetypes. Now, three of those archetypes, you’d know very well. We do information, technology, and services, and in addition that, we do intelligence as well, which I believe is the fourth archetype. And the second thing is that we’re probably the leading vendor in this industry that goes through the entire supply chain. From molecule to market, we offer services and all sorts of solutions inside there. Very unique, exciting industry, and I’m just glad to be here.

Michael Krigsman: That’s interesting. When you say, “molecule to market,” can you drill in what that means, exactly?

Richie Etwaru: So when you think about the pharmaceutical industry or the life sciences industry, the produce, right, is some sort of drug; some sort of therapy, whether it be a vaccine or a pill, or something like that; and that thing goes through a journey that starts with the discovery of a molecule, and then eventually bringing it all the way to market and being able to get it for patients to consume, etc. So that entire journey, we offer services in R&D, in compliance and commercialization, in sample management, all those areas, we’re able to stitch the pieces together for our customers. We’re kind of like a lifeblood for the industry. We’re here to enable the industry to move forward, as opposed to maybe a point solution that’s taking opportunities.

Michael Krigsman: And, you are the Chief Digital Officer. So, what does the Chief Digital Officer do at a company like QuintilesIMS?

Richie Etwaru: Well, I think it’s similar to what many Chief Digital Officers do. It’s about taking advantage of digital opportunities, as well as enabling speed, right? I think speed is the new currency, right? I think every Chief Digital Officer should, at a minimum, be a Chief Speed Officer, because you’ve got to be able to get this stuff to go very quickly. It partitions into two pieces. The first is how do you operate as an organization? Can the CDO be able to change the way how you operate, whether it’s workplace of the future, whether it’s new types of technologies that you use to be able to do things more effectively. The “how” is very important and how we operate as a company as part of what I advise and impact.

The other is the "What do we build?" The products that we actually bring to our customers; how do we take advantage of digital, etc.? A lot of that focuses on our next generation

Michael Krigsman: Welcome to Episode #235 of CxOTalk. I’m Michael Krigsman, an industry analyst and the host of CxOTalk. We have a great show, today. We’re going to be speaking with Richie Etwaru, who is the Chief Digital Officer of QuintelesIMS. It’s a really large healthcare company, and we’re going to be talking about the future of healthcare.

Before we begin, I want to say “thank you” to Livestream, which is our livestreaming partner. And, they will give you a discount on the plan if you go to Livestream.com/CxOtalk. So, thank you, Livestream. You guys are great and we love you!

So, diving in, Richie Etwaru, how are you, today?

Richie Etwaru: Hey, Michael! I’m doing fantastic, man! First of all, thank you for having me for a second time. And congratulations on keeping this show going. You’ve been a this, for what, a couple of years now? And it just keeps getting better and better; more engagement, more content, better guests, congratulations. A lot of theses start and die, but yours keeps getting better so I’m really thankful to be here.

Michael Krigsman: Hey, thank you so much! Well, you know, it’s the guests that make it, and I feel so lucky to be able to have conversations like this with folks like yourself. So, Richie, tell us about QuinteilesIMS.

Richie Etwaru: We’re a vendor that’s about 50,000 employees, about 8 billion dollars of revenues, and we’re specifically focused on the life sciences industry. It’s two things that are fairly unique about us. The first is that we operate in four archetypes. Now, three of those archetypes, you’d know very well. We do information, technology, and services, and in addition that, we do intelligence as well, which I believe is the fourth archetype. And the second thing is that we’re probably the leading vendor in this industry that goes through the entire supply chain. From molecule to market, we offer services and all sorts of solutions inside there. Very unique, exciting industry, and I’m just glad to be here.

Michael Krigsman: That’s interesting. When you say, “molecule to market,” can you drill in what that means, exactly?

Richie Etwaru: So when you think about the pharmaceutical industry or the life sciences industry, the produce, right, is some sort of drug; some sort of therapy, whether it be a vaccine or a pill, or something like that; and that thing goes through a journey that starts with the discovery of a molecule, and then eventually bringing it all the way to market and being able to get it for patients to consume, etc. So that entire journey, we offer services in R&D, in compliance and commercialization, in sample management, all those areas, we’re able to stitch the pieces together for our customers. We’re kind of like a lifeblood for the industry. We’re here to enable the industry to move forward, as opposed to maybe a point solution that’s taking opportunities.

Michael Krigsman: And, you are the Chief Digital Officer. So, what does the Chief Digital Officer do at a company like QuintilesIMS?

Richie Etwaru: Well, I think it’s similar to what many Chief Digital Officers do. It’s about taking advantage of digital opportunities, as well as enabling speed, right? I think speed is the new currency, right? I think every Chief Digital Officer should, at a minimum, be a Chief Speed Officer, because you’ve got to be able to get this stuff to go very quickly. It partitions into two pieces. The first is how do you operate as an organization? Can the CDO be able to change the way how you operate, whether it’s workplace of the future, whether it’s new types of technologies that you use to be able to do things more effectively. The “how” is very important and how we operate as a company as part of what I advise and impact.

The other is the "What do we build?" The products that we actually bring to our customers; how do we take advantage of digital, etc.? A lot of that focuses on our next generation P&L, to make sure that we're building things that are relevant in the future. What's unique about being a vendor like QuintilesIMS is that we are not the end-consumer organization, right? This is not Estée Lauder, Pfizer, etc. We're actually servicing those types of end-consumer organizations, so that at the same time, while we’re figuring out how we change, and what we bring to market, we have to be enabling our customers to change as well.

You could think of IBM as a good archetype, right? A good example of the archetype. I’m sure Bob Lord at IBM does the job the same way. How we do what we do? What is it that we provide, and how does that enable our customers to change?

Michael Krigsman: So, this is all within the context of healthcare, yet you do not directly touch patients. You're touching the drug companies and researchers. Is that correct, as I understand it?

Richie Etwaru: This is precise, right? We’re the lifeblood to drive the industry forward. If you think about Bloomberg, for example, in financial services, Bloomberg does not necessarily touch the end0investor, but they enable their financial services industry to move forward, and that’s sort of a good anecdote, or a good analogy of how we enable the pharmaceutical and life sciences industry.

Michael Krigsman: And, you know, I find it really fascinating that this notion o a Chief Digital Officer within the context of healthcare, obviously is a major indicator of the kind of changes healthcare is undergoing right now, right? I mean, you're rooted in changes in the transformation of healthcare.

Richie Etwaru: Right! Not just the industry, but the actual existence of the capacity for mankind. I think that healthcare is exciting and one of the reasons why I wanted to be here is because we're going through sort of a cyclical change that every industry has gone through. If you're a human being on this planet and specifically in the United States today, when you experience the consumer segment, or you experience the financial services segment, and in many cases of transportation segment, and even with government, things have gotten a little bit more democratized, right? Information is more at your fingertips. You’re able to make decisions better. These are more consumer-friendly, customer-friendly industries.

Healthcare hasn’t necessarily gone through that paradigm. And so, we’re having this sort of responsibility to make sure that we can bring healthcare, the industry, and more it forward into a place where, when I interact with my doctor, it feels exactly like how I interact with my banker, or my car servicing department. Right now, some government agencies are actually more customer-friendly than your doctor, or he hospital! So it’s a big part of that change. There are some macro-changes that are going on within healthcare that you may want to think about this as an insider view. Because there’s a lot of excitement around the digital and the wearables, and I want to talk about those as well. But, I think that’s only half of the conversation.

The other half of the conversation is what are these macroeconomic structural things that are going on? If you want to package that to be able to discuss them, one is, the center of gravity of the industry is changing, right? This has been an industry where, like many other industries, the control was sort of in the middle, right? In the manufacturing. We're seeing that center of gravity being distributed out to the edge of the network now, where the patients are more empowered, right? Where the providers are more empowered. Where the payers are more empowered. And this is very good for everyone. And everyone's happy about it! Including the folks in healthcare. Because it makes for a better market structure.

The second thing is where the knowledge and the information is held. Healthcare is moving just like financial services moved from an industry that had to provide answers to now an industry that has to provide evidence. When you think about financial services, I remember about fifteen-sixteen years ago, I was on the phone with my broker, and I stopped and realized, while on the phone, “Wait, I know more about this transaction than you, right? I no longer want to ask you for the answer, I want to tell you what I think and have you provide evidence to that for me.” So healthcare is sort of moving in that direction where you see the democratization of all the information about the efficacy of drugs, about best practices, about therapeutic areas being democratized out and now the center is providing evidence.

And the last is digital. Digital in healthcare is very interesting and important, but also somewhat of a dematerialization is going on. We’ve got a lot of assets in this industry whether it's molecules, or whether it's inventory management, these physical assets, that we need a digital layer above it so that we can dematerialize them and start to think about supply and demand and right-fitting and right-purposing, and outcome-based decisions, all these things are ongoing which makes it very interesting. That’s the other half of the debate that when you couple it with all the things around wearables and all the rest of things that are going on, you see this boiling pot of excitement within healthcare.

Michael Krigsman: So, with all of these changes that are taking place, what is the pathway to making this more distributed and to ultimately changing the relationship between payer, between the insurance companies, between the patients, between the doctors; because, it seems that ultimately that’s where it ends up.

Richie Etwaru: So, if you ask what is the biggest area that I focus on in the industry, about 60-80% of what I focus on is no siloes. And I know that sounds really cliché, like, we’ve been arguing that siloes are not good, and not great for a very long time, but I spend a significant amount of time just removing siloes: siloes from individual organizations, as well as siloes from the industry, right? How do you bring some of these non-familiar stakeholders together to work in an intimate way? And that requires that integration is built, which is a lot around interoperability, and a lot around standards, and a lot around information sharing. And it also requires that trust is built so that people could share information in a very trusted way. I believe that healthcare today, we have all of the data, and all of the experts and all of the invention and R&D needed to move healthcare forward to the next stat that it should be in. The issue, specifically in these parts of the world, is that we actually do not collaborate and interoperate with each other in an ecosystem formation so that we can actually share and move things forward. This is a very, very much siloed industry, and I’ve spent a lot of my time going “No siloes! No siloes!” Just like Marc Benioff goes, “No software!”, we could be “No more silos!” people, right? We’re taking siloes out.

Michael Krigsman: Are you thinking about this, when you say “Removing the siloes,” are you talking about inside your company? And, you’re a very large company, right? What is your revenue?

Richie Etwaru: We're about 8 billion dollars in revenue, about 50,000 people. We are very, very horizontally set up, which means that we've strung all these assets that we've put together on this dimension of molecule-to-market. But as we go to our customers, which is the first layer of siloes that need to be removed, we look at our customers' organizations, and R&D is very much different in a pharmaceutical company. This is where you discover the drug, this is where you do the clinical trials, this is where you build the evidence, this is where you submit it to the government to get approval. R&D is very different from commercial operations. Commercial operations, which is, "Yes, we have something now that can save lives and improve lives, and we need to bring it to market. How do we build education around that? How do we build delivery networks around that? How do we build sample management, pricing, payer, distribution, all that type of stuff?" Those are two very, very specific siloes right now in a pharmaceutical industry.

But if you … at a pharmaceutical company… if you look at the industry itself. You’ve got the provider area, which are all the hospital networks, the accountable care organizations, the doctor of practices; you’ve got the payer area, which could be large payers like insurance companies or those that self-insure, right? You’ve got a whole area of scientific and academic research, and then you’ve got the manufacturing side of the industry. And those supply chains really haven't been modernized or optimized for digital commerce today. And I think that’s what I mean by taking siloes out of the industry.

If you think about financial services today. Financial services, the industry itself, there's a lot of pipes that have been built inside of the industry to make sure that it moves faster, starting with initial things like the DTCC, right, which were put together by the banks for the banks to be able to help streamline and remove those siloes, that’s where we are in healthcare today. And as a vendor that has been able to string the pieces together ourselves, we’re able to now help our customers string the pieces together.

Michael Krigsman: We have an interesting question from Twitter, which is actually similar to what I was just thinking about asking you, as well. And, Arsalan Khan says how are you breaking down siloes that were built over a long time within the government? So, by the government. So, much of this industry structure has been established over the course of decades. Much of it in place by government regulation. And so, how do you break down those siloes? How do you even begin to do that?

 Richie Etwaru: Well, I think this is not rocket science, per say, but it’s difficult, right? It’s not difficult to understand but it’s difficult to do, which is the point of the question. Financial services has gone through the same things. We’ve seen some of that in the transformation industry, granted they’re going through it differently today.

There are things that I like to talk about which are sort of like Layer One, which are … There are no regulatory or structural limitations why they just can’t happen, right? So, if you think about the basic scenario of you or I going to a doctor. Today, simple things like every time you go to the doctor, you have to fill out your information all over again, and many times, on a piece of paper, right? Those are things that you don’t necessarily need massive, regulatory change to be able to create a strain of consistency within the industry to be able to take that out. And there are tons of benefits to that, right? Apart from the cost and the speed, there’s a notion of carried context, where different practitioners can be able to do that. So that’s sort of the base level, right?

The second level above that are […] would think … that I like to think about around supply and demand. There are pockets within this industry of therapeutic brands, whether it be drug or vaccines, where there is too much in one area, okay? And they’re expiring, and they have to be destroyed within compliance, rules, and laws, and where certain parts of the world, the last billion of the world, for example, has a hard time getting things like antibiotics, okay? If you think about the last billion of the world, they have cell phones but not antibiotics. And there is tons of research about this stuff. So, there's that second layer where we can start to think about supply and demand, and how we write sites and write fit supply and demand.

And that third layer is when you come up against some of the more structural things. Which is, how do you share patient information across various therapeutic areas or countries so that you can get larger sample pools for clinical trials so that you can be able to take out false positives better and remove variation out of the therapies that we bring to market? That’s where that difficulty comes in where you start to think about regulations and HIPAA compliance and all that type of stuff. But for the most part, there is so much low-hanging fruit still to be taken out not because they’re not good, smart people there, it’s just the timing that the industry is going through this transformation to be able to take out the siloes.

Michael Krigsman: So, taking out the siloes, this is not primarily a … This is not a technology issue, this is an issue of what? Why isn’t it happening, and what needs to be done? Where’s the catalyst to make it happen?

Richie Etwaru: Yeah. So, you're absolutely right. A lot of this technology is the first inch, but the last mile, right? It's a thing that triggers the conversation initially, which is the first inch, and then there are tons of cultural and political and structural and process and governance things that have to happen, and then it becomes the last mile of the implementation.

A couple of triggers. One is just the general economics of the industry. We’re seeing a focus on taking cost out, and as a result, that’s driving a lot of calls for efficiency, and standardization, and horizontal capabilities. So, I think that’s the first thing. The second is the call for value. A lot of people talk about the call for cost in healthcare, but not a lot of people talk about the call for value, right? Because the power is moving to the edge of the network, and you’re getting things like patient advocacy groups, right, and outcome-based discussions about the efficacy of a drug. Suddenly, we’re seeing that value is a conversation. Right-fitting a drug to a patient is very, very important. And these are the two levers that are moving that are creating a type of structural strain that’s asking every organization, not just pharmaceutical companies, pays hospitals, etc. to look at the operating model and go, “Hey! Maybe, I have an operating model that wasn’t focused on the right things. What does that look like now?” And the answer to that many times is I’ve got to think about having a more horizontally-based organizational design or operating model, where I have shared services, where I have information exchange, where I have consistency. And these are the things that are triggering that conversation. But tech? First inch, and last mile.

Michael Krigsman: When you say the change to the healthcare operating model, with which group are you talking about? Are you talking about hospitals? Are you talking about doctor’s offices? Insurance companies? Where do the changes need to occur, and where are the changes happening most readily?

Richie Etwaru: Yeah. So, I think there's a lot of change in … or a lot of VC venture capitalist investment and private equity investment on the delivery side, which is the doctor's office, the patient experience, the hospital organization, new types of smart devices that may be able to build out or orally demand signals for the industries. So there's a lot of hype and focus in that space. Having said that, the back-end sort of very important, but not as sexy work is starting as well. Which is around, "How do you look at clinical trials more effectively?" If you think about this industry today, I think the last indicators that I saw, and I don't have the specific numbers in front of me, but you could find them and I'll give you ranges. It takes anywhere from 10-12 years from the moment that you discover a molecule to be able to bring it to market successfully, 10-12 years because of all the clinical trials that are required, and very important that you have to go through and the processes that you have to go through.

But, if you think about the actual science that happens in that 10-12 years, you could potentially happen within three years, unless you have some sort of longitudinal study that requires six years of a timeline. But a lot of that waste is in manual processes, as in going from one silo to another, and those have to be taken out. By the way, the cost of that 10-12 years is somewhere about 2 billion dollars, right? It takes about 2 billion dollars to spend to bring a drug successfully to market. If you compare that to something like a car company, maybe Mercedes-Benz for example. From the time Mercedes-Benz drives the first car, to the time you can drive it at a showroom, is probably about three years? And maybe, half a billion dollars of cost.

So there’s tons of compression that is starting to happen within these cycles and these timelines, and that’s driving great opportunity for those companies that want to be competitive. And at the same time, it’s creating a tremendous amount of strain for those companies that want to argue on the wrong side of history.

Michael Krigsman: I want to remind everybody that we are speaking with Richie Etwaru, who is the Chief Digital Officer at QuintilesIMS, which is a large provider of … to healthcare. Richie, you're a provider of what? Can you summarize that?

Richie Etwaru: We provide four archetypes of values. Information, which is data. So think about that as Bloomberg, okay? Services, which is advisory and consulting and go to market; think about that as PWC. Technology, which is all the operational tools that help from molecule to market; so everything from a clinical trial management system to a CRM system, think about that as Salesforce, okay? And then intelligence, which are all the insights and early indicators that can help you make better decisions. I don't think there's an example there, but those are the four high-level archetypes that we provide to the life sciences industry at a global scale, right? It's a bit of an unprecedented archetype of the vendor. There aren't many industries where there's a vendor that is this large, has this much experience and knowledge of that specific industry, and provides these four value archetypes across the entire supply chain. I don’t want to talk too much about QuintilesIMS, because I don’t want to be advertising for the company, but that’s what we do.

Michael Krigsman: But and I think you are unusual, which is why I’m struggling a little bit to understand the nature of the company, and I understand why you describe it as the “glue,” because you’re providing a combination of services and technology and research support, and tools, and data. So, clearly, making the changes that we’ve been talking about requires economic and structural shifts and changes to the operating model inside the various players of healthcare. But, also, technology is playing an important role as well, and technology is going to help drive this forward. What are your thoughts on that aspect of it?

Richie Etwaru: Yeah. Absolutely. And clearly, given my role and some of my passions, this is sort of the raw material that I use, so to speak, to help remove the siloes. I think the first that I would touch on, in order of priority, is AI. And, what I think about AI, I want to make sure that we partition AI appropriately. I like to think about it as three different categories. There are the things that we know that AI could help us know better. There are things that we don’t know that AI can help us find answers to, and there are things that we don’t know that we don’t know as yet, but maybe we should know, right? And, I would be remiss if I didn’t credit Donald Rumsfeld for sort of introducing that method thinking to humanity.

We are doing a lot of stuff in category one, category two, and quite frankly starting to pioneer in category three across that entire journey. If you think about things like clinical trials for cures for some of the complex, or orphan diseases that we have today, there is a lot of analytics that has to go into who is the right patient for those trials. Where are the right parts of the world to be able to stand up those trials? What is the right cohort sect to be able to make sure that we get the best therapeutic outcome for the population of the planet? These are all areas where AI could help, whether it’s category one, category two, category three.

The second thing that I think is important here is around IoT and wearables. And here again, we need a certain sense of sobriety, right? I think we get a lot of people to get really excited about things like Fitbit, and I get excited about it as well, but we have to understand why we’re getting excited about it. If you take a look at all of the wearable devices that we have in healthcare today, and you kind of plot them on a Pareto Chart that says, “Okay, these are the ones that are most interesting to diagnosis, and these are the ones that are least interesting to diagnosis, you’ll find that unless you have a chronic condition, things like a Fitbit are really not that helpful to diagnosis. And by the way, if you did have a chronic condition, a Fitbit is a terrible heart monitor, because you actually need something that’s industrial-grade, right?

So in the space of IoT, which is really more about getting these demand signals and supply signals by monitoring and censoring the ecosystem, we have not miniaturized some of these really crucial measurement instruments as yet. Things that can measure, you know, the acidity of your bile, for example, right? These are still big instruments. I don’t even know if that’s worth measuring, but I’m giving you an example. We’re not going to be able to miniaturize all these things down to be able to wear them, and quite frankly if we can’t, we’re all going to be walking around like Inspector Gadget anyway with forty things on me at the same time. So, we have to be very sober and think about censoring of our environment, whether it’s embedded in the bed, in the steering wheel of the car, etc. etc.

And the other thing we have to be sober about is how will these actually get distributed into the network? You know, if you think about the fact that a lot of these really important measuring devices are still in quest diagnostic officer, or in hospitals, and we really haven’t miniaturized the important ones as yet, you start to ask yourself, “Well okay. What’s the delivery model here,” right? We have what, 60, 70 thousand pharmacies in the United States of America, where everyone goes in and they’re in a semi-healthcare format already? Does the pharmacy become the largest wearable, but the smallest hospital? Because, every time you go into the pharmacy, you might be able to be scanned. With things like ATMs, I think there is 400, 500 thousand ATMs in the United States of America. Those already solve for identity and security where you might be able to distribute different types of censoring to those edge points, right?

This is the type of thinking that I think falls into that category of the sobriety that we need to think about for IoT. The other two I would talk about are VR, AR, and blockchain, but maybe you want to come up for some air here before we cover those two.

Michael Krigsman: Yeah, you know, the IoT and wearables issues is quite interesting. We recently had David Edelman, who is the Chief Marketing Officer of Aetna on CxOTalk. And, he was describing some programs they have to give incentives to their members to use things like Fitbit and because … Even though there are issues with it like you described, it still can give you greater awareness and focus, and focus your attention on your healthcare and your well-being, to avoid getting sick.

Richie Etwaru: Yeah. I know. That’s a very good point. If you think about some of the thought leadership work I’ve done into human API, right? The promise of wearables is to move the high-level sort of offering design of the industry, or one away from care, and towards cure, right? “An apple a day keeps the doctor away. A lot of these early wearable devices, what they’re doing is they’re actually not interventions in biology or in chemistry. The intervention is in psychology, and you could argue that in some ways, psychology is becoming the super-science of healthcare, right? Which of these behavioral changes that are driven from this stuff? Having said that, not everybody argues that, right? Most people are arguing about the fact that you can have this stream of data that comes off your body. Think about things like “quantified self,” so that now, you can think very much more carefully about what therapeutic areas you might want to avoid and be careful around, right? What are things that may work for you? And then, there are arguments around demand signals.

Right now, the industry is set up in such a way where it’s a very supply-based industry, which is, you know, treatments are manufactured because you believe that people are suffering in these area, and there's data around it, right? Or you believe that there's suffering in this area. And there's data around it. But what wearables present is an opportunity to go out to the consumer and get the demand signals about what sicknesses are really there. And what behavioral changes people want to make, and what are the ones that they don't want to make where they prefer to be hedonistic, and then have drugs to be able to help them, right? These are the arguments. I think we’re seeing the early behavioral changes of the Fitbit. That’s a really good example, right? And you could water that down to, “Listen, if you just eat well and exercise,” that’s great. But, we’re hedonistic human beings, so I think that helps, but the true promise is in the demand signals and in the supply-side of them.

Michael Krigsman: But the problem with this, of course, you’re absolutely right. But the problem or the challenge are the economics of it, because in an environment where we have this intervention of psychology, as you were just describing, where people are more focused on preventive care using Fitbits and so-forth, where are the economics to drive that? Because it doesn't cost anything. Sure, you have to buy a Fitbit, but if you're taking a walk and watching your health, no-one's making any money on that. So, where are the economic incentives?

Richie Etwaru: Yeah. So, if you think about the P&L of the industry as an aggregate. Yes, no-one’s making revenues but there’s a specific archetype of companies in the industry that’s actually saving cost, right? So on the payer’s side, on the insurer’s side of this, you’re incentivized to be able to have people change their behavior so that you don’t have a wasteful cost that you have to pay for, similar to automotive, right? At one point, you know, if you took a safety training course, right? Your premiums would go down. I remember when I was growing up as a kid, I used to have a club on my car. I don’t know if you remember one of those, it’s a red thing that you expanded in your steering wheel, right? If you had one of those, you automatically qualified for a 5% discount.

My first startup license monitor that I did, it was monitoring drivers’ records of trucking companies, and trucking companies were able to get a discount from their insurers because their drivers were monitored. Same concept here in healthcare, which is a lot of this is not about who pays for it, it’s who avoids the cost. So if you have someone to the example that you were sharing earlier who was a little bit more healthy, right, who maybe does not have that corn muffin in the morning, but maybe has some fruits instead, because you've looked at the calorie count, and you realize that corn muffins have like four hundred calories in it, which is exactly what happened to me when I first used my Fitbit, right? I was like, "Oh, corn muffins must be safe."

The benefit to that is actually the payer. The benefit to that is the insur- … Yes, I've benefitted as a person, but from an economic perspective, there's that whole segment of the industry which are the insurers and payers that will benefit from it. So, I'd be interested to see who other than Aetna, which falls into that category, is taking the core staff in making sure that we get as much we can from the psychological, behavioral changes that can come out of this fusion of technology and psychology to help fill the gap that biology and chemistry could not have filled in healthcare.

Michael Krigsman: So, Aetna, as a payer, has an economic incentive to support its members in terms of preventive, let’s say, preventive wellness and awareness…

Richie Etwaru: Exactly. You manage to do a lot of this as well. That's another really good example. I'm sure there are others that don't come to mind.

Michael Krigsman: But, that’s only a part of the overall value chain. So, you have an incentive there for wellness. But, what about in other parts of the system where there’s an incentive for sickness?

Richie Etwaru: Yeah, so and that's where we go back to the conversation that I had earlier, right, around whether the wearables that we have today are industrial-grade enough to be able to be used to make true therapeutic treatment adjustments, right, from a doctor perspective for […]. You know, much like you have, you know, an example of a Fitbit which you could argue is sort of a low-grade heart monitor, if I may, there are industrial-grade medical devices for people with a chronic condition to monitor their heart, right? There are industrial-grade medical devices to monitor the activity of the brain and your posture and things in your spine, etc. Medtronic does a ton of things in this area.

The issue is we have two different categories of wearables right now. There is sort of the consumer-grade, which is available to the masses, and that's driving a few behavioral changes, which I think is important, and we need to extract as much as we can from that. But then, there's the industrial-grade, which is largely now just for those with chronic conditions, you’ll see a blending of those lines and I think there’s a lot more miniaturization that’s going to happen which will end up being censured inside of our existing surroundings.

Michael Krigsman: You know, I’ll just … I want to move on to some other technologies, but I’ll just mention one last point about wearables. So, I got an Apple Watch at the end of last year. And, I started getting these notifications that I thought were like spam from the watch saying, “Hey, you know, your heart rate was high at this particular moment.” And I started looking at it more closely, and I realized that in fact, my heart rate was elevated and it turned out I had an underlying condition. It was a thyroid condition; it’s fine, it’s not a big deal, I’m okay. But, the point is that the Apple Watch alerted me to a real medical condition that I had otherwise … I experienced no symptoms.

Richie Etwaru: Yeah.

Michael Krigsman: It’s extraordinary!

Richie Etwaru: Yeah. No, I think there are a couple of examples like that. You're not the only one. Maybe there are a thousand of examples like that across the industry. But, I think the censors themselves are going to have to evolve to a level of precision where that may be at industrial scale. Because, while in your case, there was actually an issue, the question is how many cases are there where there was not an issue, and it was a false positive, and we're driving hypochondria to an already strained system as opposed to you which turned out to be a very positive case, right? So, I think we have to be very careful about how we list the positive cases because they are great and I'm thankful to that it happened. But at the same time, there are ten times false positives that are happening that is creating hypochondria. And in the work that I've done in the top leadership space around the human API, we talk quite a bit about how do you triangulate between various data sources?

So right now, if I had my Apple Watch on, it would probably alert me that something is wrong because I'm on this show and my heart is running at 5x times what it would usually run, right? But, you know, if you were to look at my calendar, you would see that this show was on my calendar and you look at that and go, "Okay, I know why his heart is freaking out. It's because he's on CxOTalk, right?" So, it's that interoperability which goes back to what I talked about; removing the siloes. It's that ability to interoperate and triangulate against this stuff to take the false positives out. There's a huge issue of hypochondria that lurking in the background of some of these devices.

Michael Krigsman: I love it! I mean, you don’t hear about that. You hear about, you know, we need to be aware of our health and at the same time, yes. We’re driving hypochondria. I love it.

So Richie, let’s jump to some other technologies, and very, very, very briefly talk about AR [augmented reality] and virtual reality, but I say very briefly because we don’t have that much time left and I definitely want to talk about Blockchain.

Richie Etwaru: So, in AR/VR, there are a couple of categories. One is in medical training and research. And if you look at what Dr. Shafi Ahmed is doing, if you don’t know him you should get him on the show. I mean, this guy’s taking training and research to a whole different level. He’s on my Facebook. I think you are as well. I could connect you guys. The second is in neurosciences, right? I believe in this statement that the brain is probably one of the sickest organs in the human body. We just haven’t really diagnosed that as yet, right? I think there are people like Arshya Vahabzadeh and Milind Kamkolkar who are doing a lot of work in this phase with Singularity University.

The other is in just basic psychology behavior, right? I see Robert Scoble using VR all the time to play games and get all these experiences. Those things are being transferred to Post-Traumatic Stress Disorder. Those things are being transported to phobias; those things are being transferred to Alzheimer’s or Autism, right, which is a lot of opportunity there. But you said we’re just going to touch on that very briefly. We want to touch on Blockchain briefly just in healthcare and then maybe we can go broadly on Blockchain outside of healthcare. Just in healthcare, right?

Blockchain is a trust protocol, not necessarily a cost protocol or a speed protocol. There is tons of need for trusted relationships between healthcare stakeholders to share information today so that we can start to unlock some of the power and I think there’s going to be a lot of value there; particularly in healthcare where the information is so sensitive, right? And so, you have to make sure that you have a strong protocol of encryption and privacy and security and trust around it. I think Blockchain’s probably going to impact healthcare more than it will help impact consumer-grade companies or transportation companies. Obviously, there’s a distracting conversation around Bitcoin and financial services, but we can deal with that in your next question.

Michael Krigsman: Yeah. So, please, elaborate, you say, Blockchain is a trust protocol. And, obviously, in healthcare, all of our data is private and intensely personal. And so, how can Blockchain help support and benefit healthcare?

Richie Etwaru: So, I think we have to unpack the Blockchain protocol a little bit. And I don’t want to repeat what came off of my Ted talk, but I’ll steal bits and just drop it inside of here, right? The first thing we need to think about when we think about Blockchain is to recognize that Bitcoin is to Blockchain what AOL Chat was to the internet, okay? It’s a first instantiation of the protocol, but certainly not the most interesting, right? Inside of the Blockchain protocol is a construct of keys and encryption, and we can get into that maybe in the comment section if needed, that allows us to be able to look at a dataset and very easily, at low cost, and very quickly, know whether that dataset was tampered with. And by “tampered with,” I mean someone went in and changed something that they didn’t like in the dataset to something that they like.

And today, we as a civilization, we look at all datasets and we go, “Hmm, I’m not sure if I could trust it. I have to go to an intermediary in order to trust it.” If you needed my driver record, and I gave my driver record to you, you can’t tell very easily whether I remove the speeding that I had when I was 21 or not. It’s very difficult. So, you have to go to an intermediary, which is a Department of Motor Vehicles in order to get that. Same thing if you were to buy a house. You have to get the title in order to see who owned the house and what changes were made to it. If I give you the title to my home, you wouldn’t trust it. You would have to look to a title company, right? So we live today as a species where data cannot be easily, easily categorized as, “This was tampered with, and this wasn’t tampered with.” That’s what Blockchain does, is it allows us to easily identify datasets that were tampered with.

Now, it runs on a distributed protocol, which means that multiple stakeholders that are somewhat adjacent to each other can run in industry chains, right? And if we look at the real estate industry, you might think a mortgage company, the title company, the bank, the owner, you know; the architect and all run on a chain so that now that the information is immutable, everyone can share it and people can know when it’s being edited, etc. That’s the foundation of it. How does that impact healthcare? We can talk about that. How does it impact financial services? How does it impact commerce on a pole? There’s a lot of things that we can talk about, […] economics, Muller’s equilibrium theory of how we actually start to increase trusts in transactions to be able to bring supply and demand to a place where it’s virtually liquid.

Michael Krigsman: Well, we have about three minutes left, and so I think if you would summarize the impact or potential impact of Blockchain on healthcare, that would be really quite interesting and very relevant.

Richie Etwaru: Yeah. So, I think when we think about healthcare and Blockchain, what we have to think about, to go back to this concept of “no siloes,” right? We are removing siloes from this industry to move healthcare forward. And in order to remove siloes, one of the first things that you have to have in place, right? Again, technology is the first inch in the last mile of the transformation. One of the first things you have to have in place is information sharing. We ought to be able to share information across the siloes, and the reason why we cannot share information at industrial strength as we would like to today is quite, quite complex. Part of it is security, part of it is privacy, and part of it is trust, okay?

Now, the security and privacy Blockchain solves for within the construct of the protocol, but the outcome is now you can trust the data and anyone can look at other people’s data and trust it, right? On a permission-based network. So if you think about molecules that are discovered within pharmaceutical companies, right? If you think about the top ten pharmaceutical companies in the world, they all find molecules in order to solve specific disease states or therapeutic areas. But they may not have experts in those areas. So, I might be looking at oncology only, but I may find something in rheumatoid arthritis. Or I might be looking at derm only, but I’ll find something in the neurosciences. All of those are sitting within siloed shells within each of those ten pharmaceutical companies.

Imagine the opportunity to take just from top-10 pharma, all those molecules, put them in a place where it can be shared and trusted, and then have all of the experts that are multi-domain now look at it and go, “Wow! You guys found something that we’ve been looking for for the longest while! And we understand it! You guys found it and you didn’t understand it because you’re not experts in that therapeutic area.” That’s the type of market restructuring of supply and demand in a very liquid way to be able to think about how do we actually scale this industry up and move it forward? And that’s where Blockchain comes to play.

Michael Krigsman: We’ve got about literally a minute left. And in that last minute, please offer us your prescription for how this all comes together. I mean all of this healthcare stuff is so complex. But you’re in the middle of it. And so, in one minute, can you boil it down and share your policy advice; let’s put it that way; ;policy advice or other advice for how to make this better?

Richie Etwaru: Well, I think, first of all, I think we have to get the right style, tone, and delivery around healthcare. I think a lot of the people that are not intimate to the industry looks at it and goes, “Oh my God! Look at that industry! It’s so terrible,” right? I think we’ve got to recognize that it’s just a sequential issue of which industry is going through democratization. This is not because no-one wanted to do it, this is just a sequence by which it happened. I think that’s the first thing, right?

I think the second, it goes back to those two halves that I talked about. There’s a lot of people who are doing really, really interesting things on the West Coast of the country or some of the other innovation centers like Tel Aviv that don’t necessarily understand the hard sciences of healthcare, and I think those pieces need to come together. And we’re seeing that. We’re seeing a lot of healthcare doctors and experts start to now go into entrepreneurship. We’re seeing a lot of entrepreneurs starting to pay attention to the biology and the chemistry. I think that’s the second thing. The third is we have to be able to scope the problem. The problem that sits right in front of us is siloes. That’s it. If we can get that piece out, we might be able to scale.

Michael Krigsman: Okay! Wow! What a fast 45 minutes that has been! We have been talking with Richie Etwaru, who is the Chief Digital Officer of QuintilesIMS. Boy, I’m tongue-tied [Laughter] I can’t even say it! Tongue-tied today! Richie, thank you so much for being here on Episode #235 of CxOTalk.

Richie Etwaru: Thank you very much, Michael. I appreciate it. Thanks for the viewers. I look forward to the comments!

Michael Krigsman: And everybody, thank you for watching! We have two shows next week, so go to CxOTalk.com/Episodes. And, take a look, and please join us! Thank you so much, bye-bye!